The complete guide to breast reduction surgery

GLAMOUR

May 23, 2019

Pic: Unsplash

Three plastic surgeons share everything you need to know about the complicated but often life-altering surgery.

I
nterest in plastic surgery is at an all-time high, but stigma and misinformation still surround the industry and the patients. Welcome to Life in Plastic, a new series by Allure that aims to break down cosmetic procedures and provide all the information you'll need to make whatever decision is right for your body — no judgment, just the facts. Here, we're covering everything you need to know about breast reduction surgery. Note: This article contains images of breasts.

If you were to ask three plastic surgeons which surgery is the most gratifying to perform — professionally and emotionally — chances are, all three will say breast reduction surgery. And patients tend to agree. Breast reduction surgeries consistently rank high in patient satisfaction studies, according to the surgeons we talked to.

"It's one of the procedures where the patients are almost universally ecstatic with how things go," says David A. Sieber, a board-certified plastic surgeon in San Francisco. "They've really been kind of held hostage by the size of their breasts, which really limits them from doing a lot of activities that many other women enjoy."

Unlike the majority of other plastic surgeries, folks who undergo breast reduction surgery are typically seeking relief from physical symptoms caused by the excessive weight of large breasts, rather than those who want a cosmetic tuck here or a tweak there.

"From a symptom standpoint, people report shoulder, neck, and back pain," says Charles J. Galanis, a Beverly Hills-based board-certified plastic surgeon. "They also have shoulder grooving, where their bra straps literally grind into the skin, and they have permanent marks over their shoulder just because the weight the bra is carrying on a day-to-day basis is so significant."

Those who have experienced dramatic weight loss may have also lost the volume in their chest, but their breasts are still stretched out and sagging, leading to chafing and rashes underneath.

What does breast reduction surgery consist of?

Breast reduction surgery is an outpatient procedure performed under general anesthesia and typically takes between three to five hours, depending on the breast size. During the surgery, excess breast tissue is removed to achieve the patient's desired breast size, which Sieber says is usually "somewhere between a C and a D cup."

Immediately after the surgery, patients are dressed in a snug surgical bra with large straps and a trio of front clasps to "support the breasts and take some of the weight off of the incisions," and while they aren't completely necessary to ensure faster or perfect healing, "most people feel more comfortable when they have the extra support from the bra," says Sieber.

Galanis recommends that his patients wear the surgical bra for two weeks post-surgery, and then a "sports bra of their choosing" for an additional two to four weeks, while Sieber's golden rule is no "bras with an underwire" for six weeks because "the underwire rubs on the incision."

"It's one of the procedures where the patients are almost universally ecstatic with how things go."

As part of the surgery, some doctors will also lift the breast into a normal shape, since much of the breast tissue has been removed. "Oftentimes for patients with large breasts, the nipples are pointing downward, or they're below the breast fold, so you're not only removing excess skin and breast tissue, but you're also repositioning the nipples higher on the breast mount too," says Sieber.

What are the risks?

Breast reductions are complicated but safe procedures with few risks outside of general anesthesia, which carries some risk, no matter the surgery.

Bleeding

"One of the more common, but very fixable complications, is having bleeding in that first 12 to 24 hours after surgery, causing a hematoma," says Houston-based board-certified plastic surgeon Rukmini Rednam. "It's a dramatic surgery internally. You're really changing the whole way that your nipple gets its blood supply. So because you are going through a lot of blood vessels, it can be because there's a little blood vessel that seemed like it was fine when you closed, and then your blood pressure gets really high afterward. You get stressed out, you have a lot of pain. Anything like that in the first day, or even up to a week, can cause you to bleed."

Loss of Sensation

A less frequent complication is the loss of sensation in the nipple. While this is temporary in most cases, Galanis estimates that 15 to 20 percent of patients "will have some permanent sensitivity loss with nipples."

Breastfeeding

A common myth with breast reduction surgeries is the inability for patients to breastfeed post-surgery. However, according to Rednam, most patients will be able to breastfeed; it is only in the extreme cases where the nipple is removed and then reattached, that breastfeeding is out of the equation. Rednam does caution her patients that they will likely make less milk and need to supplement their baby's diet with formula. "You're cutting some of the connections where those milk ducts were, so you're not going to make as big of a supply," she says.

"I tell all my patients that your breasts are siblings, not twins."

Asymmetry

With all breast surgeries, slight asymmetry is generally accepted as the rule and not the exception. "I tell all my patients that your breasts are siblings, not twins," says Rednam. "So they look really similar, but they're not exactly alike. After you have a surgery, it's pretty common to sit there and stare at everything, so you look and look and you may notice little asymmetries. But almost everyone has asymmetry, even before surgery."

Scarring

Scar shape and size are dependent on technique, but patients can expect a circular scar around the areola as well as an anchor-like shape with a straight line extending from the bottom of the nipple down to underneath the breast.

"I always tell my patients there are three things that determine scarring: how well surgeons close the incision, how you're going to heal genetically, and neither of us has any control over that, and the third is what you do with the incisions after surgery," says Sieber, who puts all of his patients on a strict scar therapy program of silicone sheets and gel for the first year.

"Most patients do have concerns about the scarring," says Galanis. "But the fact that the satisfactions are so high tells me that ultimately, the scars are forgiven for the benefits of the surgery. It just far outweighs anything."

What are the benefits?

Galanis considers breast reduction a two-for-one surgery, addressing both functional and aesthetic concerns, and reports that patients' symptom relief is "almost immediate" even with the expected post-op soreness and recovery, but "the pain associated with the excess weight is almost gone right away."

It's not uncommon, says Rednam, to see girls as young as 16 or 17 (accompanied by their parents) in her practice because "their breast size has become that much of a problem in their lives that they want to have a reduction before they even turn 18."

The first few questions Rednam asks in the initial consult include, "How many bras do you wear?" and "Can you find bras?" and more often than not, patients are "ready to sign up because they've had enough problems with their large breasts so that scarring or other side effects aren't an issue for them."

Redman says that the majority of her patients aren't coming to her due to dissatisfaction with how their breasts look, but rather because of a demoralizing combination of "physical pain, emotional reasons, and discomfort in their own bodies." After the surgery, they've "literally had a weight lifted off of their shoulders." Rednam performs reductions weekly, and says it has the "highest satisfaction rate of anything I do."

What is the recovery time for patients who've had breast reduction surgery?

Despite the post-surgical compression bra that patients wear for two weeks following the procedure, the swelling takes about four to six weeks to go down, and the final results manifest within three months, according to Galanis. Restrictions from activity are highly individual, based on personal pain tolerance, but most of Galanis' patients can "get back to normal life usually in a few days to a week or two." Strenuous physical activity — aka the gym — is not recommended for two months.

How much does it cost?

The price of breast reduction surgery varies based on location and insurance plans, however, according to the American Society of Plastic Surgeons, the average cost of breast reduction for "aesthetic" patients only, which is health insurance lingo for those who "are not covered by insurance," according to Sieber.

Reductions that are categorized are "non-aesthetic" have been deemed medically necessary by the patient's health insurance provider and a portion of the cost would be absorbed by insurance as long as "certain criteria is met, like back pain, neck pain or shoulder strap grooving, and the amount of breast tissue to be removed must also be significant," he says.